occlusograms

8/18/2019 occlusograms

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Source: JCO on CD-ROM (Copyright © 1998 JCO, Inc.), o!u"e 198# $e%(9# - 1&'):

he C!inic! *+e o Occ!u+ogr"+

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he C!inic! *+e o Occ!u+ogr"+

RR/ 0. 0I2, DDS, MSD

he 3!ue o p!+ter "o4e!+ in per"itting three-4i"en+ion! +tu4ie+ o

"!occ!u+ion+ or 4igno+i+ n4 tret"ent p!nning n4 + reerence throughout

tret"ent h+ o%+cure4 the 3!ue o other "etho4+ o 3ie5ing "!occ!u+ion+, +uch

+ %y t5o-4i"en+ion! occ!u+ogr"+.

Occ!u+ogr" Metho4+

n occ!u+ogr" i+ 1:1 repro4uction o the occ!u+! +urce+ o p!+ter "o4e!+ on

+heet o cette trcing pper. centr! groo3e cut into the %c6+ o %oth "o4e!+cn %e u+e4 to orient upper trcing to !o5er trcing ($ig. 1). hi+ centr! orienttion

groo3e cn %e cut into the %c6+ o %oth c+t+ %y cu+to"-"4e 4ent! c+t

+cri%er7 or tringu!r !e oun4 in ny hr45re +tore cn chie3e re+on%!e

re+u!t. One +i"p!y +cri%e+ centere4 perpen4icu!r !ine on the %c6+ o %oth c+t+,

u+ing +"!! +ure. he !e cn then %e u+e4 to cut groo3e+ o eu! 4epth in

the c+t+ +i"u!tneou+!y ($ig. #).

0hen occ!u4ing occ!u+ogr"+, one +hou!4 turn the upper trcing o3er +o tht the

+!ic6 +i4e o the trcing pper ce+ up. hi+ 5i!! in+ure tht right n4 !et +i4e+ o

the upper n4 !o5er trcing+ coinci4e.

*+eu! n4 ccurte occ!u+ogr"+ cn %e "4e in 3riety o 5y+. Dr. Chr!e+

;ur+tone o the *ni3er+ity o Connecticut 4e3e!ope4 n occ!u+ogr" c"er

++e"%!y tht u+e+ %o? c"er ( '>"" c"er 5ith 1:1 !en+ 4oe+ not

h3e the !" +i@e nece++ry or 1:1 repro4uction o 4ent! c+t+), 4ent! c+t

+tge, t5o Aoo4 !ight+, n4 hinge4 B!e?ig!+ p!te ($ig. '). #1&"" !en+ i+ u+e4

to pro4uce 1:1 "gniction, n4 Bo!roi4 !" 4ptor per"it+ in+tnt !"

4e3e!op"ent. Dr. ;ur+tone+ techniue i+ +ophi+ticte4 "etho4 o pro4ucing 1:1

occ!u+! repro4uction+ o 4ent! c+t+, %ut it h+ the 4i+43ntge o reuiring

e?pen+i3e n4 +crce euip"ent.

he Ortho+cn c"er (no !onger 3i!%!e) 5+ 4e+igne4 or 1:1 intror! occ!u+!Bo!roi4 photogrph+, %ut it cn !+o pro4uce ccurte 1:1 photogrph+ o 4ent!

c+t+. *nortunte!y, the 4epth o e!4 o thi+ c"er i+ !"o+t ni!, n4 the centr!

orienttion groo3e on the %c6+ o the "o4e!+ i+ pt to %e 4i+torte4 n4 inccurte.

nother techniue i+ the u+e o copying "chine to copy the occ!u+! +urce+ o

the 4ent! c+t+. he i"ge+ re uite c!er, %ut they re en!rge4 %y + "uch +


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1& 4epen4ing on the "chine u+e4, +o c!inic! ccurcy "y %e +eriou+!y

un4er"ine4 5ith thi+ techniue.

he "o+t pri"iti3e techniue or "6ing ccurte 1:1 occ!u+! repro4uction+ i+ to

trce the occ!u+! +urce+ o the teeth onto c!er 1E8 p!+tic +heet tht i+

+ecure4 gin+t the 4ent! c+t. Since the eye o the 3ie5er i+ the c"er, the3ie5er+ he4 "u+t not %e "o3e4 5hi!e trcing %oth +i4e+ o the "o4e!. 0ith

"ini"u" o prctice, high!y ccurte trcing+ cn %e "4e 5ith ine?pen+i3e

"teri!+ ($ig. ). Since the "e+ure"ent+ 5ere "4e %y in4epen4ent, un%i+e4 in3e+tigtor+

u+ing +ophi+ticte4 techniue, the re+u!t+ (%!e I) +hou!4 %e 3!i4.

he "e+ure"ent+ on thi+ +"p!e o occ!u+ogr"+ !e4+ to +o"e +ugge+te4

gui4e!ine+:

1. 2ch upper tooth touche+ t5o !o5er teeth %e!o5 it, 5ith the e?ception o the !+t

upper "o!r, 5hich h+ on!y the !+t !o5er "o!r to %ite gin+t.

#. he %iting e4ge o the upper nterior teeth !ie+ in ront o the %iting e4ge o the

!o5er nterior teeth %y n 3erge o .G"" (nterior o3eret).

'. he upper po+terior teeth e?ten4 %eyon4 the !o5er po+terior teeth %y n 3erge

o #.'"" on ech +i4e (po+terior o3eret).


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. he upper "o!r+ re 5i4er thn the !o5er "o!r+ %y n 3erge o 1.


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+ignicnce incre+e+. he "en+ o ;o!ton+ 4t n4 our+ 5ere uite c!o+e, %ut

the other +tti+tic+ 3rie4 gret!y.

One other +tti+tic tht ;o!ton "entione4 %rieAy in hi+ rtic!e' 5+ the coeFcient o

corre!tion %et5een the o3er!! rtio n4 the nterior rtio, 5hich 5+ u+e4 to

"e+ure the inter4epen4ence %et5een the t5o rtio+. he +ignicnce o thi+"e+ure"ent incre+e+ + it pproche+ 1, 5hich i+ perect corre!tion. $ro" hi+

4t, ;o!ton c!cu!te4 coeFcient o corre!tion o .>. e 4"itte4 tht thi+ 5+

not prticu!r!y high corre!tion, %ut conc!u4e4 tht it 5+ +ignicnt enough to

encourge hi" to 4e3e!op hi+ chrt o tooth +i@e n!y+i+ 5hich i+ +o 5i4e!y u+e4

to4y. o5e3er, our 4t re+u!te4 in coeFcient o corre!tion o on!y .1#, 5hich

in4icte+ tht there i+ !itt!e, i ny, corre!tion %et5een the o3er!! rtio n4 the

nterior rtio hereore, thi+ +tu4y 4oe+ not +upport Dr. ;o!ton+ concept.

he c!inic! i"portnce o thi+ contr4iction o ;o!ton cn %e i!!u+trte4 5ith t5o

c+e+ ro" our +"p!e (%!e I). Btient L19 h4 "n4i%u!r cu+pi4-to-cu+pi4

"e+io4i+t! "e+ure"ent o '#"". he ;o!ton n!y+i+ Chrt in4icte+ tht the"?i!!ry nterior teeth +hou!4 "e+ure "". o5e3er, they "e+ure .'"",

5hich +ugge+t+ tht they re too 5i4e %y '.8"". ;ut, 5hen one !oo6+ t the

"o4e!+ n4 occ!u+ogr"+ o thi+ ptient ($ig. ), it i+ o%3iou+ tht no +uch

4i+crepncy e?i+t+ tht thi+ i+ n i4e! rrnge"ent o teeth.

Btient L1< h4 "n4i%u!r cu+pi4-to-cu+pi4 "e+ure"ent o '


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the pro?i"! contct+. he occ!u+! +hpe o ech tooth cn then %e trce4 in n

i4e! po+ition on thi+ %+ic rch, n4 cu+to"i@e4 i4e! !o5er rch or" cn %e

con+tructe4 n4 u+e4 throughout tret"ent ($ig. 8).

rch ength Di+crepncy Me+ure"ent

he occ!u+ogr" !+o per"it+ the c!inicin to "6e high!y ccurte n4 re!i%!e

rch !ength 4i+crepncy "e+ure"ent+ %y +uperi"po+ing the i4e!i@e4 !o5er rch

or" on the origin! ($ig. 9).

Occ!u+! Si"u!tion+

Mrcotte n4 ;ur+tone +ugge+te4 +etting the "?i!!ry teeth roun4 n i4e!i@e4

!o5er rch or" +o tht it 5ou!4 %e po++i%!e to 4o n occ!u+! +i"u!tion, or 5ht i+euphe"i+tic!!y 6no5n + +et-up: 5ithout the ti"e n4 inccurcie+ inherent in

p!+ter "o4e! techniue. Occ!u+! +i"u!tion+ per"it the ortho4onti+t to uic6!y

+ee i the "?i!!ry teeth e3en h3e the po++i%i!ity o occ!u4ing 5ith the !o5er

correct!y.

In the p+t 5e h3e re!ie4 upon the tooth +i@e n!y+i+ or 4eter"ining interrch

tooth +i@e 4i+crepncie+, %ut the c!inic! u+e o occ!u+ogr"+ h+ "4e it c!er ho5

ue+tion%!e the ccurcy o the ;o!ton Rtio+ i+. hi+ +tu4y h+ re3e!e4 ho5

3rie4 the percentge+ o upper to !o5er tooth "++e+ cn %e n4 +ti!! %e nor"!.

he "o+t ccurte 5y o 4oing tooth +i@e 4i+crepncy "e+ure"ent i+ to

peror" n i4e! occ!u+! +i"u!tion 3i occ!u+ogr"+, to +ee i the teeth 5i!! ttogether 5ithout "e+io4i+t! !tertion. hi+ i+ 5hy nor"+ or occ!u+ogr"+ nee4 to

%e e+t%!i+he4. nyone co"p!eting cour+e in 4ent! nto"y h+ ir i4e o

ho5 teeth +hou!4 t together, %ut there h+ not %een ny +tu4y 3i!%!e to +ho5

ho5 i4e! occ!u+ion+ t together 5hen +een 3i occ!u+ogr"+.

u3er+on< n4 n4re5+> h3e 5i+e!y +ugge+te4 tht i"proper torue n4Eor tip on

the nterior teeth 5i!! !i"it 3i!%!e rch !ength, n4 tht i+ certin!y true. 0hen

upper nterior teeth, in prticu!r re not tippe4 n4 torue4 correct!y, +pce or

proper occ!u+ion i+ !o+t. Broper o3eret i+ eu!!y i"portnt. $or in+tnce, 5hen one

!oo6+ t the o!!o5ing C!++ II 4i3i+ion # c+e, it +ee"+ tht there i+ no c!inic!

nterior o3eret ($ig. 1&). Hot "ny c!inicin+ 5ou!4 ttri%ute "ore thn !"" onterior o3eret to thi+ c+e. /et 5hen 5e !oo6 t thi+ ptient 3i occ!u+ogr"+, 5e

"e+ure '"" o nterior o3eret. hi+ i+ the true nterior o3eret n4 it gret!y

inAuence+ the tip n4 torue o the nterior teeth7 %ecu+e, + the+e i"proper!y

inc!ine4 teeth continue to erupt, the "?i!!ry n4 "n4i%u!r inci+or+ te!e+cope

o3er one nother +o tht 5i4er prt o the "?i!!ry inci+or i+ engge4 %y the

inci+! e4ge o the "n4i%u!r inci+or. hi+ te!e+coping, +i"u!tneou+!y, inc!ine+ the


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"n4i%u!r inci+or !ingu!!y +o tht it+ occ!u+ion i+ no5 !ingu! to the "?i!!ry

centr!+ cingu!u", 5hich i+ tht tooth+ 5i4e+t prt.

0hen teeth h3e proper tip n4 torue, they h3e the highe+t po++i%i!ity or proper

o3eret, 5hich in our +"p!e rnge4 ro" #.'"" to & n4 3erge4 .G"". It i+

rre ptient 5ho cn +ho5 "" o o3eret n4 !+o 4e"on+trte ccept%!e tipn4 torue o the nterior teeth. hey go hn4 in hn4, +o tht 5hen i4e!

occ!u+ogr"+ re 4e+igne4 5ith 1"" o nterior o3eret, one i+ ++u"ing correct

tip n4 torue or the inci+or+ too.

ooth +i@e 4i+crepncie+ re r "ore co""on thn 5e h3e %een !e4 to %e!ie3e %y

tr4ition! ;o!ton Rtio+. he ptient +een in $igure 11 i+ typic! o ptient+ in 5ho"

no ;o!ton Di+crepncy i+ oun4 5hen c!++ic! ;o!ton Rtio+ re u+e4. ;ut 5hen

4igno+tic occ!u+ogr"+ re u+e4, o%3iou+ interrch tooth-+i@e 4i+crepncie+ re

re3e!e4. One cou!4 tret thi+ ptient A5!e++!y, %ut ne3er chie3e r" C!++ I

occ!u+ion. o5 oten 4oe+ thi+ occur in prcticeN Or4inri!y, the ortho4onti+t +hrug+

n4 "utter+ +o"ething %out !o+ing upper "o!r nchorge, 5hen, in ct, there5+ ne3er ny po++i%i!ity o rrnging the+e teeth in r" C!++ I occ!u+ion 5ithout

!tering the +i@e+ o the teeth.

Mo+t tooth +i@e 4i+crepncie+ re !i6e the one i!!u+trte4 %o3e, in tht they in3o!3e

+uper%un4nce o !o5er tooth "++. hi+ pre+ent+ the ortho4onti+t 5ith +e3er!

!ternti3e+: 1) e cn rrnge the upper po+terior occ!u+ion in C!++ I

re!tion+hip n4 !e3e +pce in the upper nterior +eg"ent. #) e cn incre+e

the +i@e o +o"e upper nterior teeth (u+u!!y the !ter! inci+or+) 3i c6et+ +o tht

i4e! tooth +i@e cn %e ttine4. ') e cn re4uce the !o5er tooth "++ %y

interpro?i"! po!i+hing or, in +o"e c+e+, e!i"inte !o5er inci+or !together. here

re ti"e+ 5hen ech o the+e !ternti3e+ or co"%intion o the" "ight %echo+en7 %ut or4inri!y the interpro?i"! re4uction oKer+ the "o+t re+on%!e n4

!e+t oKen+i3e pproch.

Se3er! yer+ go, C3itron Corportion h4 thin-%!4e in+tru"ent tht 5+ u+e4

5ith it+ u!tr+onic prophy!?i+ unit or interpro?i"! po!i+hing. o5e3er, 5hen the

D, ine?p!ic%!y, 5ith4re5 it+ ppro3! o the in+tru"ent 4e+pite it+ pro3en +ety

n4 u+eu!ne++, C3itron +toppe4 "6ing it. Ortho4onti+t+ 5ere then !et 5ith on!y

their i"gintion n4 3ery e5 in+tru"ent+ tht cou!4 re4uce teeth interpro?i"!!y,

n4 +i"u!tneou+!y recontour n4 protect the teeth ro" uture crie+.

*nite6 Corportion recent!y intro4uce4 n u!tr+onic prophy!?i+ unit tht !en4+it+e! uite nice!y to interpro?i"! re4uction n4 !+o per"it+ 3rition in the 5ter

+pry +o tht the Auori4e-!u"inu" o?i4e p+te 5i!! not %e uic6!y 5+he4 5y +

the en"e! re4uction i+ %eing 4one.

;eore the u!tr+onic po!i+hing tip cn %e p!ce4 interpro?i"!!y, it i+ nece++ry to

gin +o"e +pce %y po!i+hing 5ith either "nu! or e!ectric interpro?i"!,

4i"on4-encru+te4 +tripper ($ig. 1#). he eKecti3ene++ o the+e interpro?i"!


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+tripper+ cn %e gret!y incre+e4 5ith the +i"u!tneou+ u+e o the Auori4e-

!u"inu" o?i4e p+te. hi+ p+te 5i!! !+o e?ten4 the u+eu! !ie o the+e po!i+hing

tip+. I the nterior teeth re tight!y !igne4, it i+ +o"eti"e+ nece++ry to u+e

"echnic! +eprtor to gin cce++. Once cce++ i+ 3i!%!e, the u!tr+onic

in+tru"ent cn %e u+e4 uite eKecti3e!y ($ig. 1').

$igure 1< i!!u+trte+ ptient 5ho h4 n un4etecte4, +eriou+ tooth +i@e

4i+crepncy. ret"ent 5+ +trte4 n4 the ptient 5+ uite cooperti3e. he

po+terior teeth 5ere "o3e4 into C!++ III rrnge"ent, %ut there 5+ +ti!! not

enough +pce to "o3e the "?i!!ry cu+pi4+ 4i+t!!y into r" C!++ I.

Occ!u+ogr"+ re3e! the pro%!e" re too "uch !o5er tooth "++ %y

ppro?i"te!y


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occlusograms

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